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Patients with Stable Glaucoma More Likely to be Depressed than Those with Progressive Disease: Presented at ARVO

By Cameron Johnston

FT. LAUDERDALE, FL -- May 8, 2003 -- Researchers found that patients with stable glaucoma were 2.5 times more likely to be depressed about their condition than those whose vision was deteriorating measurably.

At the annual meeting of the Association for Research in Vision and Ophthalmology here May 7^th researchers from University of Toronto, in Canada, presented the findings from a study of 884 patients treated at a tertiary care glaucoma clinic.

Patients were recruited through the university's glaucoma research centre, which is part of the department of ophthalmology and is also affiliated with the Toronto Hospitals. The stability of the patient's disease was based on comparing three visual field progression tests that were done over a mean period of 5.5 years.

Depression was defined by the Center for Epidemiological Studies (CES) Depression Scale, in which a series of questions are scored on a 4-point scale and added together. A total score of 16 means there are no depressive symptoms, while a score of 60 represents the most depressed one could possibly be.

According to Dr. John Flanagan, director of the research unit, patients whose disease was stable had smaller cup-to-disk ratios and better visual acuity, and they were more often in the early and moderate stages of the disease, as expected. Surprisingly, however, they also had more psychiatric co-morbidities and significantly more depressive symptoms on the CES depression scale (24% versus 11.4%) compared with patients who had progressive disease.

Using multiple logistic regression analysis to explore the relationship between the disease and depressive symptoms, the researchers found that patients whose glaucoma was stable were 2.5 times more likely to experience depressive symptoms than were those whose disease was stable, Dr. Flanagan said. When adjusted for other factors, they were 14.5 times more likely to have psychiatric co-morbidities, and 6.3 times more likely to perceive themselves to be in poor health.

There were no differences in depressive symptoms according to whether the patient had normal tension glaucoma, primary open angle glaucoma or ocular hypertension.

From a clinical point of view, Dr. Flanagan said, these factors could play a role in whether or not patients are compliant with their medications.

An interesting sidebar, Dr. Flanagan explained, was that the depression data was originally compiled as part of a sleep disorders study and it found that sleep patterns could also have an impact on the progression of glaucoma.

People who are depressed and taking antidepressant medications are more likely to experience nocturnal hypotension, he said, and there is an inverse relationship between systemic blood pressure and intra-ocular pressure while a patient is sleeping. However, people who have sleep disturbances, he said, are less likely to have nocturnal hypotension, and therefore, for these patients, their interrupted sleep actually confers a protective benefit on their eyes, Dr. Flanagan said.


[Study title: The Toronto Hospital Glaucoma Health and Sleep Survey: Depressive Symptomatology in Glaucoma Patients in a Tertiary Care Setting. Abstract 4361/B20]

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